Brain Death Disputes

Shlomo Zuckier presents an interesting variety of Jewish perspectives on brain death at Jewish Ideas Daily. 

A brief definition before jumping in: Brain death occurs when a person’s brain activity, including that of the brain stem (which controls the respiratory and cardiovascular systems), has irreversibly ceased. People who are brain-dead may be kept alive temporarily with a ventilator and other life support systems; without such devices, they would die.

Once brain death has occurred in someone who has agreed (or whose family has agreed) to donate his or her organs, doctors may harvest the organs, and the patient will die.

So is brain death basically the same as death? As Zuckier writes, the stakes in this issue “could not be higher,” for “if a brain-dead patient is in fact still living but we harvest his organs, we have killed him,” whereas “if the patient (is) in fact dead but we wrongly fail to harvest his organs, a person in need of them may die on our account.” You can read his piece to learn about how the debate has played out in the Jewish context.

The Catholic Church, for its part, generally defers to medical definitions of brain death (as John Paul II phrased it in one address , “with regard to the parameters used today for ascertaining death . . . the Church does not make technical decisions”). Organ donation is considered praiseworthy, as long as it is conducted in an ethical manner. Yet the standard method used to determine whether someone is, in fact, brain dead should give us pause. 

Dick Teresi, who published a book on this topic a few months ago, describes the basic tests thus :

 A doctor splashes ice water in your ears (to look for shivering in the eyes), pokes your eyes with a cotton swab and checks for any gag reflex, among other rudimentary tests. It takes less time than a standard eye exam. Finally, in what’s called the apnea test, the ventilator is disconnected to see if you can breathe unassisted. If not, you are brain dead. (Some or all of the above tests are repeated hours later for confirmation.)

And that’s the extent of it. There’s no test for higher-brain activity, though the original committee behind today’s brain death exam had recommended such testing. As Teresi discovered,

In at least two studies before the 1981 Uniform Determination of Death Act, some “brain-dead” patients were found to be emitting brain waves. One, from the National Institute of Neurological Disorders and Stroke in the 1970s, found that out of 503 patients who met the usual criteria of brain death, 17 showed activity in an EEG.

Seventeen out of some five hundred is not a huge number—-but it’s large enough to be unsettling, and perhaps to justify revisiting how we decide whether a patient is dead.